Background:  The advantages of starting ART at acute infection are still studied in clinical trials. However, patients who received this strategy over the last decade can already be analyzed for long-term outcome. The objective of the study was to analyze the long-term outcome (>10 years) of a series of patients who were initially treated at the time of acute infection with combinations of 3 or 4 drugs.

Methods:  Between 1995 and 2000, 58 patients with acute HIV infection were treated in 3 different hospitals in our area with cART. We selected patients with a last follow up available in 2011.

Results:  We identified 45 patients. The 13 remaining cases were either lost of follow up (11 cases, median of 3 years after acute infection) or died in an accident (2 cases). Ten out of these 45 patients initially received 3 RTI, 23 received 2 RTI + 1 PI/r and 12 received 2 RTI + 2 PI. The median duration of ART at acute infection was 2.2 years. The median follow up of this series is 12 years. Eight patients never resumed any ART, while others did after a median period of 5 years off therapy. The reason for resuming ART was a CD4 count <350/mm³ in each case. Two out of the 8 cases who never resumed ART have HIV plasma RNA permanently <20 copies/mL and peripheral blood mononuclear cell (PBMC) HIV DNA <40 copies/million cells (but HIV DNA is still detectable in lymphoid rectal cells). These 2 patients have normal CD4/CD8 ratio and are HLA B27 and B57 negative. The remaining 6 patients are still off therapy with a median viremia level of 2,500 copies/mL and CD4 >350. Plasma viremia is <20 copies/mL in all the 37 patients who restarted ART, with 8 of them showing PBMC HIV DNA <40 copies/million cells.

Conclusions:  Spontaneous long-term control of HIV replication was observed in 17% of patients who were treated for 2 years at acute infection. Undetectable levels of HIV reservoirs can be achieved when ART is initiated at acute infection.